Plantar fasciitis is probably the most common cause of pain under the heel. It is inflammation or more likely degeneration of the thick band of tissue under your foot called the plantar fascia. Symptoms usually develop gradually over time and are worse first thing in the morning, but ease as your foot warms up.
Medically reviewed by Dr Chaminda Goonetilleke, 20th Jan. 2022
Symptoms
Symptoms of Plantar fasciitis usually develop gradually over time and include:
- Pain under the heel
- Sometimes the pain radiates into the arch of your foot
- Tenderness under your heel when pressing in
- Pain is usually worse first thing in the morning
- Symptoms improve as your foot warms up, but return later
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Other injuries which are sometimes confused with Plantar fasciitis are Bruised heel, Heel spur and Calcaneal stress fracture.
What is Plantar fasciitis?
Plantar fasciitis is inflammation (or degeneration) of the Plantar fascia at the point it attaches to the heel.
Anatomy
The Plantar Fascia (or plantar aponeurosis) is a broad, thick band of tissue that runs from under the heel bone (calcaneus), to the front of the foot. Its function is to provide support to your foot when standing and shock absorption when running.
Plantar fasciitis or Plantar fasciopathy?
The term Plantar fasciitis describes inflammation (‘itis’ means inflammation). Traditionally people thought inflammation was the problem. However, studies now show inflammatory cells are not present in most cases.
Therefore, degeneration of the tissues is a more likely cause. In this case, the term Plantar fasciopathy is probably more accurate because it describes degeneration/wear and tear.
What causes Plantar fasciitis?
Overuse is the main cause, however, there are a number of factors which increase your chances of developing it. These are:
Foot biomechanics – for example, overpronation where your foot rolls in or flattens too much when running or walking. Or if you have a rigid, high-arched foot.
Inappropriate footwear – such as very flat or unsupportive shoes. Or wearing the wrong running shoes for your foot type.
Bodyweight – if you are heavy or overweight then this increases the load on your foot.
Flexibility – if you have tight calf muscles or plantar fascia then you are at a higher risk of this injury.
Read more detail on PF causes.
Download our App to access our step-by-step Plantar Fasciitis rehab program: iPhone & Android
Plantar fasciitis treatment
Treatment involves the following to reduce pain and inflammation and relax the tissues:
Cold therapy – Apply ice or cold therapy every couple of hours for 10 to 15 minutes to reduce pain and inflammation. Reduce to 3 times a day as symptoms improve.
Taping – often instantly relieves symptoms by supporting the arch of the foot. It reduces strain on the plantar fascia, which allows tissues to heal.
Footwear – wear comfortable shoes or trainers and avoid hard or flat-soled shoes.
Insoles & heel pads – cushioning heel pads or insoles help relieve pain. If overpronation is an issue then orthotic-type insoles are more appropriate.
Plantar fasciitis night splint – is worn overnight and helps prevent the fascia and calf muscles from tightening up.
Massage – deep tissue massage helps stretch and relax the plantar fascia.
Electrotherapy – your physio may use Extracorporeal shock wave therapy or Ultrasound therapy.
Medication – anti-inflammatory medication such as ibuprofen may be effective in the early stages to reduce pain and inflammation. However, long-term use may actually inhibit healing.
Gait analysis – involves analysing your feet and how you walk and run. If you overpronate, or your feet flatten then orthotic inserts may be prescribed to correct biomechanical issues
Injections – for more stubborn injuries a doctor may try a corticosteroid injection. Platelet-rich plasma injections have also been shown to be effective. If symptoms do not resolve then surgery is an option but this is rare.
Read more detail on PF treatment.
Plantar fasciitis exercises
Exercises to stretch the plantar fascia and the calf muscles are particularly important. Rest alone may reduce pain and inflammation but if part of the cause is tension in the fascia then your pain is likely to recur.
Our Plantar fasciitis rehab program includes the following types of exercises:
- Stretching for the plantar fascia and calf muscles including foot rolling.
- Strengthening of the foot and plantar fascia as well as the posterior chain (legs and hips).
- Activation exercises to keep the hip muscles firing and in good condition.
- Movement control to maintain balance and proprioception.
- Functional exercises to bridge the gap between basic rehab and sports-specific training.
Learn more about specific Plantar fasciitis exercises or go direct to our Plantar fasciitis rehabilitation program.
Download our App to access our step-by-step Plantar Fasciitis rehab program: iPhone & Android
Plantar fasciitis surgery
Surgery is used in around 5% of people whose symptoms do not improve after a minimum of nine months of continuous treatment. However, the success rate is still only estimated at around 70-80%.
In most cases now, a procedure called a plantar fascia release is performed. This releases (cuts) between 30 and 50% of the fascia’s fibres, reducing the stress on the fascia. Complications can include nerve damage, fallen arches, infection, and ongoing symptoms. Recovery after surgery if successful is around 9 to12 weeks before the patient may return to work.
References & Research
- Lemont H, Ammirati KM, Ulsen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93(3):234-37
- Riddle DL, Pulisic M, Pidcoe P et al. Risk factors for PF: a matched case-control study. J Bone Joint Surg Br 2003;85-A(5):872-7
- Gonnade N1, Bajpayee A2 et al Regenerative efficacy of therapeutic quality platelet-rich plasma injections versus phonophoresis with kinesiotaping for the treatment of chronic PF: A prospective randomized pilot study. Asian J Transfus Sci. 2018 Jul-Dec;12(2):105-111
- Malahias MA, Cantiller EB, Kadu VV, Müller S. The clinical outcome of endoscopic plantar fascia release: A current concept review. Foot Ankle Surg. 2018 Dec 23. pii: S1268-7731(18)30233-9
